Does Medicare Cover Sinemet?

Steven Mott by Steven Mott | Licensed since 2012
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This article was updated on: 09/12/2018

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The brand-name prescription Sinemet also may get prescribed as a generic medicine called carbidopa and levodopa and is used to treat Parkinson’s disease. Original Medicare Part A and Part B only covers prescriptions in specific instances. You may need a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage in order to cover Sinemet.

What is Sinemet?

This combination of two amino acids (carbidopa and levodopa) provides the brain with the precursor to dopamine, according to the FDA. Prescription drugs that can help the brain produce more dopamine can help treat symptoms of Parkinson’s Disease, such as muscle stiffness, tremors, spasms, and poor muscle control, according to the U.S. National Library of Medicine. Sinemet comes in tablets that have different strengths and proportions of the two prescription drugs, carbidopa and levodopa.

How Medicare covers Sinemet

Medicare Part A and B may not cover a Sinemet prescription. Part A usually only covers inpatient prescriptions taken in a hospital or other facility. Part B helps cover certain types of prescription drugs that typically get administered inside of a clinic. Typically, Medicare Part A and Part B won’t cover prescriptions that patients take home and administer themselves. If a doctor prescribes Sinemet to get filled at a local pharmacy and taken home, Medicare beneficiaries will generally need a Medicare Part D Prescription Drug Plan for coverage. A number of Medicare Advantage plans include drug benefits, so this would be another alternative to choosing a stand-alone Part D Prescription Drug Plan.

To learn how any Medicare prescription drug plan option covers Sinemet, ask to see the formulary. This is a list of covered prescriptions that insurers must supply. It should also have information about how different brand-name, specialty, and generic prescriptions will be covered. For instance, the generic form of Sinemet might cost less than the brand-name form. Insurance companies do have a right to change their plan formulary at their discretion, but they must send out notices to their enrollees.

Consider Medicare plan options for Sinemet

Would you like to find out if you can find a better Medicare plan option to cover Sinemet? If so, I will work to help you. To get started:

  • Schedule a personal call or ask for a personalized email by clicking an option below.
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